title: Prevalence of pediatric periodic leg movements of sleep after initiation of PAP therapy.
abstract: BACKGROUND
  Positive-airway-pressure (PAP) is a treatment for obstructive-sleep-apnea (OSA). In adults, initiation of PAP-therapy may unmask periodic-limb movements-of-sleep (PLMS). We present a series of children in whom PLMS was aggravated or induced following initiation of PAP therapy.
  
  
  METHODS
  Retrospective analysis was performed on children who had PAP-studies performed over a 3-year period. Children with OSA without significant PLMS on baseline studies and who then showed a periodic-limb-movement-index (PLMI) (>5/hr) during titration with PAP-therapy were identified. Charts were reviewed for demographics, OSA severity based on apnea hypopnea index (AHI), PLMI, PLM-arousal-index (PLMAI) and pressures titrated.
  
  
  RESULTS
  Two hundred fourteen PAP-titration studies (151 on continuous positive airway pressure [CPAP] and 63 on bilevel positive airway pressure [BiPAP]) were done. Eleven (10 on CPAP, 1 on BiPAP) met study criteria. Eight patients were boys. The median age was 12 years (range 6 months-18 years). On baseline studies, median AHI was 5/hr (range 1.5-32/hr), median PLMI was 1/hr (range 0-4/hr) and median PLMAI 0.3/Hr (range 0-2/hr). On titration studies, pressures ranged from 4 to 14 cm of water, median AHI was 0.5/hr (range 0-1), median PLMI was 12/hr (range 5-55/hr) and median PLMAI 9/hr (range 0-25). PLMS were seen predominantly during N1, N2 sleep and on PAP of >7 cm of water. One patient had resolution of PLMS at 1-year follow-up.
  
  
  CONCLUSIONS
  PLMS were seen in 5.1% of children after initiation of PAP. OSA may mask PLMS, which appears as breathing improves. Alternatively, PAP may unmask or induce PLMS. PLMS may potentially be a cause of treatment failure in children on recent-onset PAP therapy.
authors.affiliation: Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Pediatric Sleep Disorders, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Vidya
authors.initials: V
authors.lastname: Pai
authors.forename: Umakanth
authors.initials: U
authors.lastname: Khatwa
authors.forename: Sriram
authors.initials: S
authors.lastname: Ramgopal
authors.forename: Kanwaljit
authors.initials: K
authors.lastname: Singh
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fitzgerald
authors.forename: Sanjeev V
authors.initials: SV
authors.lastname: Kothare
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D020189:Nocturnal Myoclonus Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D017286:Polysomnography; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000628:therapy*
keywords: PAP-therapy; PLMS; children; polysomnography